EYECARE SPECIALISTS MEDICAL GROUP, INC. (NPI# 1255649612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255649612 |
| Entity Type | Organization |
| Organization Name | EYECARE SPECIALISTS MEDICAL GROUP, INC. |
| Other Organization Name | ATLANTIS EYECARE |
| Practice Address |
1360 W 6th St North Bldg Suite 125 San Pedro CA 90732-3514 |
| Mailing Address |
888 S Disneyland Dr 100-b Anaheim CA 92802-1847 |
| Practice Telephone | 5629389945 |
| Practice Fax Number | 5624960433 |
| Mailing Telephone | 7146044621 |
| Mailing Fax Number | 7148293232 |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2010-09-22 |
| Authorized Official Name | DR. DWAYNE K LOGAN (PRESIDENT) |
| Authorized Official Telephone | 7146044643 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207W00000X | Ophthalmology | G68583 | CA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Atlantis Eyecare | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114547619 | Eyecare Specialists Medical Group, Inc. | Optometrist | 1711 W Temple St Ste 5665, Los Angeles, CA 90026-5421 | 2020-04-24 |
| 1538791025 | Eyecare Specialists Medical Group, Inc. | Optometrist | 1595 E 17th St, Santa Ana, CA 92705-8506 | 2020-02-12 |
| 1942392238 | Eyecare Specialists Medical Group, Inc. | Optometrist | 475 W. Badillo St., Covina, CA 91723-1902 | 2006-09-28 |
| 1619597119 | Eyecare Specialists Medical Group, Inc. | Optometrist | 231 W Vernon Ave Ste 104, Los Angeles, CA 90037-2778 | 2020-04-24 |
| 1922529700 | Eyecare Specialists Medical Group, Inc. | Ophthalmology | 490 Post St Ste 933, San Francisco, CA 94102-1414 | 2017-06-30 |
| 1154878478 | Eyecare Specialists Medical Group, Inc. | Ophthalmology | 7677 Center Ave, Suite 102, Huntington Beach, CA 92647-3074 | 2016-09-02 |
| 1790173508 | Eyecare Specialists Medical Group, Inc. | Optometrist | 22525 Maple Ave, Suite 100, Torrance, CA 90505-2700 | 2014-12-31 |
| 1750488169 | Eyecare Specialists Medical Group, Inc. | Optometrist | 7677 Center Ave, Suite 301, Huntington Beach, CA 92647-3074 | 2006-09-20 |
| 1487762159 | Eyecare Specialists Medical Group, Inc. | Optometrist | 23521 Paseo De Valencia, Suite 305, Laguna Hills, CA 92653-3107 | 2006-08-25 |
| 1568494649 | Eyecare Specialists Medical Group, Inc. | Optometrist | 8311 Florence Ave, Downey, CA 90240-3928 | 2006-07-07 |
| Street Address |
1360 W 6TH ST NORTH BLDG SUITE 125 |
| City | SAN PEDRO |
| State | CA |
| Zip Code | 90732-3514 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821092859 | Carmen C Capodanno | Dermatology | 1360 W 6th St, Ste 270, San Pedro, CA 90732-3539 | 2005-06-08 |
| 1760832851 | Harbor Foot and Ankle Podiatric Medical Group | Podiatrist | 1360 W 6th St, Suite 150w, San Pedro, CA 90732-3514 | 2016-06-20 |
| 1861850141 | Rebecca Li | Physical Therapy Assistant | 1360 W 6th St, Suite 210, San Pedro, CA 90732-3514 | 2016-02-02 |
| 1891176616 | Bruce D. Levine, D.p.m., Professional Corporation | Non-Pharmacy Dispensing Site | 1360 W 6th St, Suite 150, West Building, San Pedro, CA 90732-3514 | 2015-06-17 |
| 1750799771 | Matin R Hemmat | Internal Medicine | 1360 W 6th St, Suite 120 West Building, San Pedro, CA 90732-3514 | 2014-07-23 |
| 1457790339 | San Pedro Surgery Center, Inc. | Clinic/Center | 1360 W 6th St, Suite D, San Pedro, CA 90732-3514 | 2013-06-24 |
| 1740539048 | Lori Rochelle Krieger | Pediatrics | 1360 W 6th St, Suite 300, San Pedro, CA 90732-3514 | 2012-08-31 |
| 1083997985 | Barry Rodgveller Dpm Podiatry Corporation | Podiatrist | 1360 W 6th St, Suite 240, San Pedro, CA 90732-3514 | 2011-09-27 |
| 1205135878 | James T London M D A Professional Corporation | Orthopaedic Surgery | 1360 W 6th St, Suite 305, San Pedro, CA 90732-3569 | 2011-03-22 |
| 1316248313 | Peter D. Sliskovich, Md, Inc. | Family Medicine | 1360 W 6th St, Suite 120 West Building, San Pedro, CA 90732-3514 | 2010-11-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538771241 | Alicia Avila | Student in an Organized Health Care Education/Training Program | 2227 Blue Butterfly Way, #7, San Pedro, CA 90732 | 2020-08-24 |
| 1619500543 | Udana Harris | Registered Nurse | 1300 West 7th Street, Obhc Unit, San Pedro, CA 90732 | 2020-02-19 |
| 1861042301 | Patricia Elaine Moses | Technician | 106 N. Western Ave Unit 102, San Pedro, CA 90732 | 2019-09-17 |
| 1629627393 | Antonio Ramon Martinez | Technician | 3141 Blue Butterfly Unit 66, San Pedro, CA 90732 | 2019-09-05 |
| 1487207700 | Victoria A. Shook, D.d.s., A Professional Corp. | Dentist | 28138 S. Western Ave., San Pedro, CA 90732 | 2019-07-17 |
| 1144566563 | Shaun E Chandran M D Inc | Orthopaedic Surgery | 1360 W 6th Street, Suite 305, San Pedro, CA 90732 | 2012-12-13 |
| 1316281280 | Jenny Luong | Physician Assistant | 1534 W. 25th St, San Pedro, CA 90732 | 2012-11-16 |
| 1033429519 | Eric M Feit Dpm Inc | Podiatrist | 1360 West 6th St., Suite 240, San Pedro, CA 90732 | 2010-10-18 |
| 1386808673 | Meysam Zaker | Dentist | 2470 S. Western Ave, San Pedro, Ca, CA 90732 | 2008-07-15 |
| 1376735340 | Francisco J. Correa, M.d., Inc | General Practice | 1350 W. 6th St, #3, San Pedro, CA 90732 | 2007-08-14 |
| Find all providers in zip 90732 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972501237 | Tay Justin Weinman | Ophthalmology | 571 W 7th St, San Pedro, CA 90731-3115 | 2005-07-11 |
| 1073537817 | Kenneth Joel Miller | Ophthalmology | 1360 W 6th St, Suite 215, San Pedro, CA 90732-3514 | 2006-07-26 |
| 1619991460 | Geula Madani-becker | Ophthalmology | 1360 W 6th St, Suite 215, San Pedro, CA 90732-3514 | 2006-07-26 |
| 1033131933 | Kenneth J Miller Md A Medical Corp | Ophthalmology | 1360 W 6th St, Suite 215, San Pedro, CA 90732-3514 | 2006-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831790922 | Paul B Kouyoumjian, Md Inc. | Ophthalmology | 18040 Sherman Way Ste 205, Reseda, CA 91335-4631 | 2020-11-04 |
| 1700496320 | William Thomas Parker | Ophthalmology | 5279 Gaylord Pl, San Diego, CA 92117-1034 | 2020-08-07 |
| 1588274724 | Katerina Kurteeva Md Inc | Ophthalmology | 3140 Bear St Ste 100, Costa Mesa, CA 92626-2964 | 2020-08-03 |
| 1285252502 | Eyecare Specialists Medical Group, Inc | Ophthalmology | 58-471 29 Palms Hwy, Yucca Valley, CA 92284-5818 | 2020-07-13 |
| 1407473754 | Janet K. Kim Md, Inc | Ophthalmology | 903 Crenshaw Blvd Ste 105, Los Angeles, CA 90019-1972 | 2020-07-02 |
| 1699392506 | Desert Ophthalmology Medical Corporation | Ophthalmology | 72650 Fred Waring Dr Ste 109, Palm Desert, CA 92260-5008 | 2020-06-26 |
| 1942821566 | Simon Eyes, Inc. | Ophthalmology | 3260 Beard Rd Ste 5, Napa, CA 94558-3466 | 2020-05-05 |
| 1942821905 | Nathan Abraham Md Vision Professionals Inc | Ophthalmology | 24305 Town Center Dr Ste 160, Valencia, CA 91355-1347 | 2020-04-30 |
| 1720609878 | Don Saul Ellis | Ophthalmology | 343 11th St, Del Mar, CA 92014-2607 | 2020-04-29 |
| 1245851534 | Santa Barbara Eyecare Inc., A Professional Medical Corporation | Ophthalmology | 2946 De La Vina St, Santa Barbara, CA 93105-3310 | 2020-04-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.